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This study aimed to examine patients\u2019 and clinicians\u2019 perspectives of the psychosocial, clinical, and relational impact of fibromyalgia as a co-diagnosis in SARDs. We employed explanatory mixed-methods study integrating survey data from 1269 adults with SARDs, and interviews with patients (n\u2009=\u200919) and clinicians (n\u2009=\u200921). Outcomes included wellbeing (WEMWBS, 14\u201370), trust, confidence in receiving medical help, adaptation, satisfaction with care (all 1\u20135), and self-rated health (0\u2013100). Independent t-tests compared outcomes by fibromyalgia status and by patients\u2019 diagnostic acceptance. Qualitative open-text responses and interviews were analysed thematically. Among participants (95.1% female n\u2009=\u20091207; lupus 31.0% n\u2009=\u2009393 and rheumatoid arthritis 31.3% n\u2009=\u2009397), fibromyalgia was reported by 25.9% (n\u2009=\u2009329) of whom 52.8% (n\u2009=\u2009174) questioned diagnostic accuracy. Compared with those without fibromyalgia, affected participants reported significantly lower wellbeing (mean difference(SD)\u2009=\u2009-4.206(0.608)), trust in GPs (mean difference(SD)\u2009=\u2009-0.239(0.092)) and rheumatologists (mean difference(SD)\u2009=\u2009-0.515(0.097)), confidence in receiving help (mean difference(SD)\u2009=\u2009-0.459(0.073)), and satisfaction with care (mean difference(SD)\u2009=\u2009-0.563(0.073)), alongside poorer adaptation (mean difference(SD)\u2009=\u2009-0.223(0.066)) and life satisfaction (mean difference(SD)\u2009=\u2009-0.519(0.071)), but higher self-rated health (mean difference(SD)\u2009=\u200911.107(1.411); all p\u2009&lt;\u20090.05). Diagnostic acceptance showed minimal quantitative differences across outcomes. Thematic analysis highlighted that diagnostic uncertainty was driven by overlapping symptoms and limited biomarkers. Variations in clinician practices affected patients\u2019 trust and acceptance. Furthermore, misdiagnosis and dismissal led to stigma, delayed recognition of conditions, and considerable patient distress. In SARDs, fibromyalgia diagnosis is associated with poorer wellbeing and reduced trust in healthcare providers, irrespective of diagnostic acceptance, and often reflects diagnostic uncertainty. Mechanism-based explanations may help improve communication and provide greater clinical utility than categorical diagnostic labelling.<\/jats:p>","DOI":"10.1007\/s00296-026-06143-y","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:27:49Z","timestamp":1780536469000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fibromyalgia in systemic autoimmune rheumatic diseases: a mixed-methods study of patient and clinician perspectives"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4154-6687","authenticated-orcid":false,"given":"Dorsa","family":"Manavi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7960-7870","authenticated-orcid":false,"given":"Alice","family":"Tunks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Diment","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2416-8134","authenticated-orcid":false,"given":"Alessandra","family":"Bortoluzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1426-474X","authenticated-orcid":false,"given":"James A.","family":"Bourgeois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7098-688X","authenticated-orcid":false,"given":"Lucy","family":"Calderwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8153-9064","authenticated-orcid":false,"given":"Melanie","family":"Sloan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"6143_CR1","unstructured":"Bhargava J, Goldin J. 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JAB has received speaking fees from Psychiatric Times and Oakstone and receives royalties from American Psychiatric Publishing, Springer International, Lippincott Williams & Wilkins, and Cambridge University Press. All other authors declare no potential conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Patients were actively involved throughout every stage of this study, including contributing to the development of the research question and survey to ensure relevance to patient priorities and lived experience. Patients participated in the study through completion of surveys and qualitative interviews. Two patient partners are co-authors on this manuscript and contributed to study interpretation and reporting. The findings will be disseminated to patients and the public through sharing of the published article and lay summaries.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient and public partnership"}},{"value":"This manuscript has not been published previously and is not under consideration for publication elsewhere, in whole or in part. No part of this work has been copied from other sources.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}},{"value":"AI-assisted large language model tools were used solely for language editing and grammatical refinement only, accessed during manuscript preparation (2026). All authors reviewed and approved the final manuscript and take full responsibility for its accuracy and integrity.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Use of artificial intelligence"}}],"article-number":"128"}}